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Do we pay too much tax for crappy services?

1246

Comments

  • Closed Accounts Posts: 2,281 ✭✭✭CrankyHaus


    The HSE is an excellent example of an inefficiently run public service, in fact it's a perfect microcosm of the worst aspects of public sector inefficiency:

    Expensive, poor service delivery, lots of cushy numbers for overpaid staff poorly performing redundant tasks who cannot be fired.

    Ironically but characteristically it combines this inefficiency with an often crushing workload on frontline staff who work hard performing the essential healthcare tasks and who basically keep the show on the road. A similar dichotomy can be found in much of the public sector and it explains why many public servants who work hard resent generalisations about it, however well founded, as "public sector bashing".

    The health service also has a unique amount of profiteering by private interests, most visibly private consultants who take advantage of the two tier health system to the detriment of the public interest despite them experiencing first hand the negative effects of this in their public practice and career up to this point. This is a cultural blindspot within the medical profession where junior doctors bitch hard about their unconscionable working hours and conditions but wilfully refuse to join the dots between this and the two-tier system they hope to make a killing off as private consultants once they climb up the ladder.


  • Registered Users, Registered Users 2 Posts: 18,781 ✭✭✭✭kippy


    theguzman wrote: »
    I hope for your own sake that you never have the misfortune for requiring the HSE. The HSE is an uter shambles, a corrupt, inept disgrace. If you gave someone a mandate on how to squander money and setup something so unfit for purpose they could not manage to create something as bad as the HSE.

    4-5 year waiting lists, over paid useless staff. Scrap PRSI and privatise the HSE and let the private sector deliver it with insurance. We should be left to opt out of the HSE since it is worthless.

    The US healthcare system is not the model we should be looking to aspire to.


  • Registered Users, Registered Users 2 Posts: 803 ✭✭✭machaseh


    CrankyHaus wrote: »
    The HSE is an excellent example of an inefficiently run public service, in fact it's a perfect microcosm of the worst aspects of public sector inefficiency:

    Expensive, poor service delivery, lots of cushy numbers for overpaid staff poorly performing redundant tasks who cannot be fired.

    Ironically but characteristically it combines this inefficiency with an often crushing workload on frontline staff who work hard performing the essential healthcare tasks and who basically keep the show on the road. A similar dichotomy can be found in much of the public sector and it explains why many public servants who work hard resent generalisations about it, however well founded, as "public sector bashing".

    The health service also has a unique amount of profiteering by private interests, most visibly private consultants who take advantage of the two tier health system to the detriment of the public interest despite them experiencing first hand the negative effects of this in their public practice and career up to this point. This is a cultural blindspot within the medical profession where junior doctors bitch hard about their unconscionable working hours and conditions but wilfully refuse to join the dots between this and the two-tier system they hope to make a killing off as private consultants once they climb up the ladder.

    If the HSE works like ****e maybe it should be fixed rather than privatizing everything. We can look to the absurd health care costs in the USA to learn that privatizing everything is not always the answer.


  • Administrators Posts: 54,091 Admin ✭✭✭✭✭awec


    I think everyone agrees the HSE needs reform, but to suggest the US model is the solution, where getting sick can literally bankrupt an individual, is laughable.

    The US model is great for people who are rich. Not so much for the rest of society.


  • Registered Users, Registered Users 2 Posts: 803 ✭✭✭machaseh


    awec wrote: »
    I think everyone agrees the HSE needs reform, but to suggest the US model is the solution, where getting sick can literally bankrupt an individual, is laughable.

    The US model is great for people who are rich. Not so much for the rest of society.

    It's not even great for people who are rich, even if you have the better half of a million quid on the bank nobody is happy paying 10 grand + for simple medical procedures such as fixing a broken leg etc. The only people it's great for is the people running the insurance companies.


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  • Registered Users, Registered Users 2 Posts: 2,081 ✭✭✭theguzman


    machaseh wrote: »
    If the HSE works like ****e maybe it should be fixed rather than privatizing everything. We can look to the absurd health care costs in the USA to learn that privatizing everything is not always the answer.

    You cannot fix the HSE, you must kill it off, several Health Ministers have tried and failed.

    Any attempts at reform or repair is resisted completely by the trade unions, for any meaningful reform of the HSE to first happen then the Unions need to be destroyed, they yield enormous power and are only interested in lining their own pockets, they don't care if poor old Mary McGinty is left waiting 6 years for cataract surgery and will go blind in mean time.

    Trade Unions are a cancer on Ireland and any public service immediately turns to sh1t because of them. Privatisation and a non-Union workforce is the only solution.

    I myself have tried to access a public consultant, it is an absolute farce, to get the surgery I need I have resigned myself to paying thousands, this is despite the crippling levels of taxation we pay already.

    Let the consumer of healthcare pay, make Health Insurance Mandatory, get rid of Medical cards, I'd gladly pay €200 - €300 a month for insurance in a proper private system, just scrap PRSI and lower the tax burden.


  • Closed Accounts Posts: 2,281 ✭✭✭CrankyHaus


    machaseh wrote: »
    If the HSE works like ****e maybe it should be fixed rather than privatizing everything. We can look to the absurd health care costs in the USA to learn that privatizing everything is not always the answer.


    I suspect you did not read my post in full.



    Much of the problem with the HSE is in fact the private elements creating a two-tier system. This is not merely inefficient in itself. It also works against reform of the HSE, as those who have the most say (the rich and powerful) are protected from its failings by private insurance. Furthermore the long term policy of our parties of government, FG certainly and most likely FF, is towards an Insurance led system, so there is no appetite to sacrifice any political capital by reforming the HSE. Do not forget that the HSE was formed under Minister of Health Mary Harney (PD) in an FF-PD coalition.



    The Insurance led model has some advantages but international comparisons show it tends towards higher costs, sometimes much higher when profiteering runs rampant (the US).


    Of course to save public services from privatisation the services have to prove themselves worthy of saving by serving the public well or public opinion will side against them. Our public sector unions have been astonishingly incapable of realising this, with the result that more and more services have been ceded to the private sector to the satisfaction or at least apathy of the public who got sick to the back teeth of being treated like dirt by a self-serving platitude-spouting Labour Aristocracy.


  • Registered Users, Registered Users 2 Posts: 18,781 ✭✭✭✭kippy


    theguzman wrote: »
    You cannot fix the HSE, you must kill it off, several Health Ministers have tried and failed.

    Any attempts at reform or repair is resisted completely by the trade unions, for any meaningful reform of the HSE to first happen then the Unions need to be destroyed, they yield enormous power and are only interested in lining their own pockets, they don't care if poor old Mary McGinty is left waiting 6 years for cataract surgery and will go blind in mean time.

    Trade Unions are a cancer on Ireland and any public service immediately turns to sh1t because of them. Privatisation and a non-Union workforce is the only solution.

    I myself have tried to access a public consultant, it is an absolute farce, to get the surgery I need I have resigned myself to paying thousands, this is despite the crippling levels of taxation we pay already.

    Let the consumer of healthcare pay, make Health Insurance Mandatory, get rid of Medical cards, I'd gladly pay €200 - €300 a month for insurance in a proper private system, just scrap PRSI and lower the tax burden.

    Private is again, not always the answer, nor is a state that is completely non unionised. One only has to look at the situation in the states where employees routinely get 10 days annual leave, have to work more than one job just to keep bread on the table and where there is abject poverty. These are not good things for anyone or society in general.

    Take a look at the work of unions in the private sector here and you'll see employees rights are well protected.
    https://www.rte.ie/news/business/2019/0710/1061284-compensation-paid-to-paddy-power-staff-over-breaks/

    Tearing the HSE to the ground and starting from scratch isn't an option - whatever change is needed has to come with the co-operation of the unions.

    "Let the consumer of healthcare pay" you say - we are all consumers of healthcare in one way or another.


  • Registered Users, Registered Users 2 Posts: 14,862 ✭✭✭✭markodaly


    CrankyHaus wrote: »
    I suspect you did not read my post in full.



    Much of the problem with the HSE is in fact the private elements creating a two-tier system. This is not merely inefficient in itself. It also works against reform of the HSE, as those who have the most say (the rich and powerful) are protected from its failings by private insurance. Furthermore the long term policy of our parties of government, FG certainly and most likely FF, is towards an Insurance led system, so there is no appetite to sacrifice any political capital by reforming the HSE. Do not forget that the HSE was formed under Minister of Health Mary Harney (PD) in an FF-PD coalition.



    The Insurance led model has some advantages but international comparisons show it tends towards higher costs, sometimes much higher when profiteering runs rampant (the US).


    Of course to save public services from privatisation the services have to prove themselves worthy of saving by serving the public well or public opinion will side against them. Our public sector unions have been astonishingly incapable of realising this, with the result that more and more services have been ceded to the private sector to the satisfaction or at least apathy of the public who got sick to the back teeth of being treated like dirt by a self-serving platitude-spouting Labour Aristocracy.

    Actually, wasn't that Michael Martin? The current leader of FF?

    The key thing about the HSE and any public service is that we lack the ability to reform it, in any way shape of fashion.
    When the politician is the guy wielding the axe but also looking for your vote, what are they going to do? Put away the axe and look for your vote

    It's an impossible position really but that is why we need strong leadership but I agree, the unions are a terrible influence on the public sector. They represent their members fine, but the manifestation is the public services we have to interact with daily. Generally poorly run, inefficient, expensive and working in an old fashioned archaic manner.


  • Registered Users, Registered Users 2 Posts: 14,862 ✭✭✭✭markodaly


    kippy wrote: »

    Tearing the HSE to the ground and starting from scratch isn't an option - whatever change is needed has to come with the co-operation of the unions.

    When are the Unions ever interested in change?
    They want to line their pockets and do the same for their members, at the cost of the rest of society. That is the nub of it.

    Unions were fine in the times before strong employment law, but in today's modern workplace, they are mostly out of date and hold the country to ransom.


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  • Registered Users, Registered Users 2 Posts: 18,781 ✭✭✭✭kippy


    markodaly wrote: »
    When are the Unions ever interested in change?
    They want to line their pockets and do the same for their members, at the cost of the rest of society. That is the nub of it.

    Unions were fine in the times before strong employment law, but in today's modern workplace, they are mostly out of date and hold the country to ransom.

    You've obviously missed the past 10 years or so. Plenty change has taken place. I am not saying it's been easy but unions are not against change. They want to protect their workers rights - granted going to far sometimes to do so.

    Look at the link I've posted to see why you still need unions even in this age of "Strong Employment Law"


  • Closed Accounts Posts: 2,281 ✭✭✭CrankyHaus


    markodaly wrote: »
    Actually, wasn't that Michael Martin? The current leader of FF?

    Michael Martin was Minister when the law establishing the HSE was passed but Harney was Minister when it was founded. I actually think that in long term health policy there was/is little difference between FF, The PDs, or FG: a slow drive towards an Insurance model with minimal sacrifice of political capital to fix the ailing public health system so that eventually few will mourn its demise. Beyond giving out some goodies to win votes Ministers of any party make minimal changes as it is seen as a career ender: whether that was Cowen describing it as "Angola" or Leo doing SFA there while giving constant press soundbites on other department's performance.


  • Administrators Posts: 54,091 Admin ✭✭✭✭✭awec


    theguzman wrote: »
    You cannot fix the HSE, you must kill it off, several Health Ministers have tried and failed.

    Any attempts at reform or repair is resisted completely by the trade unions, for any meaningful reform of the HSE to first happen then the Unions need to be destroyed, they yield enormous power and are only interested in lining their own pockets, they don't care if poor old Mary McGinty is left waiting 6 years for cataract surgery and will go blind in mean time.

    Trade Unions are a cancer on Ireland and any public service immediately turns to sh1t because of them. Privatisation and a non-Union workforce is the only solution.

    I myself have tried to access a public consultant, it is an absolute farce, to get the surgery I need I have resigned myself to paying thousands, this is despite the crippling levels of taxation we pay already.

    Let the consumer of healthcare pay, make Health Insurance Mandatory, get rid of Medical cards, I'd gladly pay €200 - €300 a month for insurance in a proper private system, just scrap PRSI and lower the tax burden.

    You'll pay 200 a month, but then you or someone in your family are unfortunate enough to become ill with something and your 200 a month premium suddenly triples to 600 a month next year because you're high risk.

    But you can't move insurer, because you have a pre-existing condition, and no other insurer will touch you, or they load your premium to account for your condition.

    Then next year, the insurance company decide that your condition is no longer covered on the payment plan you are on, you need to upgrade to a higher package. So it goes from 600 a month to 800 a month.

    You can't afford this, so you let your insurance lapse. Which means treatment stops. But then your son or daughter has a fall and breaks their leg, and you get a bill in the post for 30 grand that you now owe for the hospital fees and various consultant fees and use of equipment.

    The American system is rubbish. Big Pharma and insurance companies have been lobbying against reform of their system for years, because it'll end up hitting their profits if they move closer toward a semi-socialist health model.


  • Closed Accounts Posts: 16,013 ✭✭✭✭James Brown


    theguzman wrote: »
    You cannot fix the HSE, you must kill it off, several Health Ministers have tried and failed.

    Any attempts at reform or repair is resisted completely by the trade unions, for any meaningful reform of the HSE to first happen then the Unions need to be destroyed, they yield enormous power and are only interested in lining their own pockets, they don't care if poor old Mary McGinty is left waiting 6 years for cataract surgery and will go blind in mean time.

    Trade Unions are a cancer on Ireland and any public service immediately turns to sh1t because of them. Privatisation and a non-Union workforce is the only solution.

    I myself have tried to access a public consultant, it is an absolute farce, to get the surgery I need I have resigned myself to paying thousands, this is despite the crippling levels of taxation we pay already.

    Let the consumer of healthcare pay, make Health Insurance Mandatory, get rid of Medical cards, I'd gladly pay €200 - €300 a month for insurance in a proper private system, just scrap PRSI and lower the tax burden.

    Trade unions are a better option than private shareholders IMO.

    We pay tax because as a society we feel pooling our money best serves everyone equally in regards to health and other matters. When you bring in privatisation you bring in inequality and society suffers as a result. Irish society isn't a business. You don't treat your family based on how much money they make.


  • Registered Users, Registered Users 2 Posts: 14,862 ✭✭✭✭markodaly


    kippy wrote: »
    You've obviously missed the past 10 years or so. Plenty change has taken place.

    Can you give us some examples of this change?

    I am not saying it's been easy but unions are not against change. They want to protect their workers rights - granted going to far sometimes to do so.

    In my experience its the default position that Unions adopt in Ireland. Any change has to go through extensive negotiations and in exchange for more allowances or wage increases. Just look at the farce of Irish Rail train drivers refusing to give up their overtime and train new train drivers.


  • Registered Users, Registered Users 2 Posts: 14,862 ✭✭✭✭markodaly


    CrankyHaus wrote: »
    Michael Martin was Minister when the law establishing the HSE was passed but Harney was Minister when it was founded. I actually think that in long term health policy there was/is little difference between FF, The PDs, or FG: a slow drive towards an Insurance model with minimal sacrifice of political capital to fix the ailing public health system so that eventually few will mourn its demise. Beyond giving out some goodies to win votes Ministers of any party make minimal changes as it is seen as a career ender: whether that was Cowen describing it as "Angola" or Leo doing SFA there while giving constant press soundbites on other department's performance.

    I think the days of a political party or a Minister standing up and proclaiming to fix the HSE or the health service for all, are over.
    Every politician realises that the HSE is just too big a job for anyone party to fix, it needs buy-in from the entire political establishment.
    This is why Slaintecare was launched by a cross-party committee.

    https://health.gov.ie/blog/publications/slaintecare-action-plan-2019/

    However, to get real change, needs cross party leadership and the ability to let people go who are surplus to requirements. This needs maturity from all parties.


  • Registered Users, Registered Users 2 Posts: 14,862 ✭✭✭✭markodaly


    Trade unions are a better option than private shareholders IMO.

    We pay tax because as a society we feel pooling our money best serves everyone equally in regards to health and other matters. When you bring in privatisation you bring in inequality and society suffers as a result. Irish society isn't a business. You don't treat your family based on how much money they make.


    Spinning two separate yarns as usual Matt.

    Feelings have nothing to do with the reality of the situation.

    Where is your 'purely accountancy driven cost assessment' when it comes on taking on public vested interests and the Trade Unions? Or do you think they are operating at maximum efficiency?

    You are only interested in saving the taxpayer money so long as it's ideologically convenient and sacred cows are saved because privatisation is inherently bad? Am I right?

    I also include the Irish Hospital Consultants Association in the Trade Union bracket by the way, arguably the most powerful 'Union' in the state, along with the National Association of General Practitioners. Do you think we get good value for money from their €252,000 annual salary?

    As to the privatisation argument, some level of privitisation is good, as it relieves the public system. The more patients that can be treated by private doctors and hospitals means fewer people reliant on the public system. A hybrid system is what is best and what they have in places like Germany and Holland, where an insurance-driven model to delivering health care is optimal, with people unable to afford insurance being given subsidised insurance by the state.

    We should look at this problem with an evidence-based approach, not dogma or misty-eyed ideology or 'feelings'.


  • Registered Users, Registered Users 2 Posts: 18,781 ✭✭✭✭kippy


    markodaly wrote: »
    Can you give us some examples of this change?




    In my experience its the default position that Unions adopt in Ireland. Any change has to go through extensive negotiations and in exchange for more allowances or wage increases. Just look at the farce of Irish Rail train drivers refusing to give up their overtime and train new train drivers.

    I suspect it doesn't really matter what examples I give, you will most likely find an issue.

    1. The biggest change within the public service in the past decade is the increase in standard working week. Strangely enough there was no pay rise associated with it, the opposite in fact.
    2. The move of a large number of departments to a shared services model of HR and Payroll (Peoplepoint and the like) This is ongoing.
    3. The increased provision of digital services to the public.
    4. The centralised tendering and associated frameworks systems to increase efficiencies in procurement.
    5. The merging and consolidation of a number of different bodies.
    A few hundred other things as well.....
    https://reformplan.per.gov.ie/2014/downloads/downloads.html

    There are examples like Irish Rail, but that shouldnt be the standard that gets applied to all.


  • Registered Users, Registered Users 2 Posts: 18,781 ✭✭✭✭kippy


    markodaly wrote: »
    Spinning two separate yarns as usual Matt.

    Feelings have nothing to do with the reality of the situation.

    Where is your 'purely accountancy driven cost assessment' when it comes on taking on public vested interests and the Trade Unions? Or do you think they are operating at maximum efficiency?

    You are only interested in saving the taxpayer money so long as it's ideologically convenient and sacred cows are saved because privatisation is inherently bad? Am I right?

    I also include the Irish Hospital Consultants Association in the Trade Union bracket by the way, arguably the most powerful 'Union' in the state, along with the National Association of General Practitioners. Do you think we get good value for money from their €252,000 annual salary?

    As to the privatisation argument, some level of privitisation is good, as it relieves the public system. The more patients that can be treated by private doctors and hospitals means fewer people reliant on the public system. A hybrid system is what is best and what they have in places like Germany and Holland, where an insurance-driven model to delivering health care is optimal, with people unable to afford insurance being given subsidised insurance by the state.

    We should look at this problem with an evidence-based approach, not dogma or misty-eyed ideology or 'feelings'.

    Isn't that essentially the situation here give or take.


  • Posts: 0 [Deleted User]


    markodaly wrote: »
    When are the Unions ever interested in change?
    They want to line their pockets and do the same for their members, at the cost of the rest of society. That is the nub of it.

    swap in unions for taxpayers

    then voters

    then self employed

    then professionals

    then trades

    then pensioners

    the students

    then the lower paid

    then the unemployed

    look just swap in people into the above codswallop and be done


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  • Registered Users, Registered Users 2 Posts: 14,862 ✭✭✭✭markodaly


    kippy wrote: »
    I suspect it doesn't really matter what examples I give, you will most likely find an issue.

    1. The biggest change within the public service in the past decade is the increase in standard working week. Strangely enough there was no pay rise associated with it, the opposite in fact.
    2. The move of a large number of departments to a shared services model of HR and Payroll (Peoplepoint and the like) This is ongoing.
    3. The increased provision of digital services to the public.
    4. The centralised tendering and associated frameworks systems to increase efficiencies in procurement.
    5. The merging and consolidation of a number of different bodies.
    A few hundred other things as well.....
    https://reformplan.per.gov.ie/2014/downloads/downloads.html

    There are examples like Irish Rail, but that shouldnt be the standard that gets applied to all.

    Just to take a few points, but first of all, the increase of the working week was vehemently resisted by the Trade Unions at the time but was agreed to as a) no one had to lose their jobs and b) it capped the pay cuts during the 2011 crash.

    The fact now though is that the Unions want to go back to their 35 hour week.
    https://www.irishtimes.com/news/ireland/irish-news/public-servants-to-seek-shorter-working-week-and-reversal-of-extra-hours-1.3881961
    Public servants are to seek a shorter working week and the abolition of extra hours agreed during the financial crisis, in a move the Government estimates would cost more than €600 million.

    So yea, not exactly a ringing endorsement of Trade Unions facilitating change.

    Many of the other points are straight from a Committee powerpoint presentation but they all lack detail and meaningful metrics or benchmarks.


  • Posts: 0 [Deleted User]


    markodaly wrote: »
    Just to take a few points, but first of all, the increase of the working week was vehemently resisted by the Trade Unions at the time but was agreed to as a) no one had to lose their jobs and b) it capped the pay cuts during the 2011 crash.

    The fact now though is that the Unions want to go back to their 35 hour week.
    https://www.irishtimes.com/news/ireland/irish-news/public-servants-to-seek-shorter-working-week-and-reversal-of-extra-hours-1.3881961



    So yea, not exactly a ringing endorsement of Trade Unions facilitating change.

    Many of the other points are straight from a Committee powerpoint presentation but they all lack detail and meaningful metrics or benchmarks.

    lol

    "change happened but the unions didnt propose it

    also all those changes dont count"

    listen, would u not.


  • Registered Users, Registered Users 2 Posts: 14,862 ✭✭✭✭markodaly


    kippy wrote: »
    Isn't that essentially the situation here give or take.

    No. We have a system where if you can afford private insurance you grab it, as otherwise, you will be waiting years for elective procedures. Many times these will be done in public hospitals anyway, it's just a method to skip a queue, or perhaps get a nice rebate if you have something done privately.

    Otherwise its a mess, as there is no imposition on the HSE, the hospitals or any publicly funded health provider to up their game and offer services in a more efficient manner. The Dutch model, the money follows the patient, therefore the patient has a choice to what hospital to go to.

    We have the youngest population in the EU yet have one of the worse outcomes in terms of spend per captia.
    Money is not the issue, its the system itself is not fit for purpose and to fix or reform the system, eggs have to be broken, so to speak.

    HSE overspent for last year is projected to be over €700 million. I can't find the link right now, but I heard that since 2012 or so, HSE overspent the guts of €3 Billion, the cost of a new Children's Hospital.


  • Registered Users, Registered Users 2 Posts: 14,862 ✭✭✭✭markodaly


    lol

    "change happened but the unions didnt propose it

    also all those changes dont count"

    listen, would u not.

    The point I was making was thus:

    A poster stated that Unions are not against change in an earlier post, yet as I demonstrated they clearly are. Change has to be forced onto them, usually, by negotiation but sometimes unilaterally in times of a crisis.


  • Registered Users, Registered Users 2 Posts: 18,781 ✭✭✭✭kippy


    markodaly wrote: »
    Just to take a few points, but first of all, the increase of the working week was vehemently resisted by the Trade Unions at the time but was agreed to as a) no one had to lose their jobs and b) it capped the pay cuts during the 2011 crash.

    The fact now though is that the Unions want to go back to their 35 hour week.
    https://www.irishtimes.com/news/ireland/irish-news/public-servants-to-seek-shorter-working-week-and-reversal-of-extra-hours-1.3881961



    So yea, not exactly a ringing endorsement of Trade Unions facilitating change.

    Many of the other points are straight from a Committee powerpoint presentation but they all lack detail and meaningful metrics or benchmarks.
    As I said:
    "I suspect it doesn't really matter what examples I give, you will most likely find an issue."
    You asked me to give you examples of change. I gave numerous examples and linked you to a plethora of documentation around public service reform and documents that reviewed the success of that reform. These reports would contain the metrics and benchmarks you are looking for but look, it's much easier continue with an opinion not based on facts.


  • Registered Users, Registered Users 2 Posts: 18,781 ✭✭✭✭kippy


    markodaly wrote: »
    The point I was making was thus:

    A poster stated that Unions are not against change in an earlier post, yet as I demonstrated they clearly are. Change has to be forced onto them, usually, by negotiation but sometimes unilaterally in times of a crisis.

    But surely if Unions are against change, there would be no change?
    (Change is of course a very broad catch all)


  • Registered Users, Registered Users 2 Posts: 18,781 ✭✭✭✭kippy


    markodaly wrote: »
    No. We have a system where if you can afford private insurance you grab it, as otherwise, you will be waiting years for elective procedures. Many times these will be done in public hospitals anyway, it's just a method to skip a queue, or perhaps get a nice rebate if you have something done privately.

    Otherwise its a mess, as there is no imposition on the HSE, the hospitals or any publicly funded health provider to up their game and offer services in a more efficient manner. The Dutch model, the money follows the patient, therefore the patient has a choice to what hospital to go to.

    We have the youngest population in the EU yet have one of the worse outcomes in terms of spend per captia.
    Money is not the issue, its the system itself is not fit for purpose and to fix or reform the system, eggs have to be broken, so to speak.

    HSE overspent for last year is projected to be over €700 million. I can't find the link right now, but I heard that since 2012 or so, HSE overspent the guts of €3 Billion, the cost of a new Children's Hospital.

    I'm not disagreeing with you in general on the HSE and the fact that there is lots of room for improvement.


  • Registered Users, Registered Users 2 Posts: 14,862 ✭✭✭✭markodaly


    kippy wrote: »
    As I said:
    "I suspect it doesn't really matter what examples I give, you will most likely find an issue."
    You asked me to give you examples of change. I gave numerous examples and linked you to a plethora of documentation around public service reform and documents that reviewed the success of that reform. These reports would contain the metrics and benchmarks you are looking for but look, it's much easier continue with an opinion not based on facts.

    I asked for examples of change, that Unions would be interested in.
    All I see there are examples of change hoisted on top Unions forced on by the Government.

    The first example you gave about the increased working week, is at this time is being used as a threat to strikes unless that change is rowed back!
    What is your opinion on that?


  • Registered Users, Registered Users 2 Posts: 14,862 ✭✭✭✭markodaly


    kippy wrote: »
    I'm not disagreeing with you in general on the HSE and the fact that there is lots of room for improvement.

    Do you not concede then that Unions and other stakeholders block reform and the ability to make the HSE and the health service at large fit for purpose?


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  • Registered Users, Registered Users 2 Posts: 18,781 ✭✭✭✭kippy


    markodaly wrote: »
    I asked for examples of change, that Unions would be interested in.
    All I see there are examples of change hoisted on top Unions forced on by the Government.

    The first example you gave about the increased working week, is at this time is being used as a threat to strikes unless that change is rowed back!
    What is your opinion on that?

    You asked for examples of change. I gave a small portion of them. If the unions werent "interested" in that change - it wouldn't have happened

    Now you're moving the goalposts. That's grand.
    It's a pointless debate.


  • Registered Users, Registered Users 2 Posts: 18,781 ✭✭✭✭kippy


    markodaly wrote: »
    Do you not concede then that Unions and other stakeholders block reform and the ability to make the HSE and the health service at large fit for purpose?

    Yeah, unions make it more difficult to reform because:
    1. It's much more difficult(impossible almost) to fire staff.
    2. It's much more difficult to redeploy staff en masse.
    3. It's generally more difficult to reduce wages.
    4. It's more difficult to amend employment contracts.
    These are all standard in unionised environments.
    But they do not "Block Reform" en masse - as I have already shown.

    The electorates expectations (which would include union members and every other joe soap) are a big issue. Everyone wants a hospital in their back yard. Everyone wants a doctor within walking distance. This in turn drives policy and politics.


  • Registered Users, Registered Users 2 Posts: 4,647 ✭✭✭beggars_bush


    I looked at my payslip this morning
    28% gone on tax, prsi, usc.

    I don't mind paying it once I know it's going to actual services and not to paying for national debt or some piece of art installation along a main road or something.

    E.g. that the local library can buy books, the hospital is open and can treat me, the potholes are fixed etc


    The people who complain about public services mustn't realise that you need admin people supporting all the frontline staff. Schools are probably the one public sector job where the vast majority of staff are frontline.
    The amount of paperwork and other duties is increasing exponentially every few years it seems to me.
    Paperwork and other duties just increase inefficiencies


  • Registered Users, Registered Users 2 Posts: 14,862 ✭✭✭✭markodaly


    kippy wrote: »
    You asked for examples of change. I gave a small portion of them. If the unions werent "interested" in that change - it wouldn't have happened

    Now you're moving the goalposts. That's grand.
    It's a pointless debate.

    There is a lot of historcal revisionism going on.
    Remember, this was the period of the crash, circa 2011.

    Changes were forced in and negotiated in part. The increase of the working week was brought in and was negotiated in exchange with the agreement of the Unions to not cut pay further.

    Now, the same Unions want to revert to the old style 35 hour week. Hardly the hallmark of a forward-thinking dynamic and modern organisation that wants to impliment the best standards in work and recruitment.


  • Registered Users, Registered Users 2 Posts: 2,367 ✭✭✭micosoft


    kippy wrote: »
    What's a 'business person'?

    Somebody like Bill Cullen or Alan Sugar or Donald Trump.

    Because delivering public services => Selling second hand Renaults.


  • Registered Users, Registered Users 2 Posts: 18,781 ✭✭✭✭kippy


    markodaly wrote: »
    There is a lot of historcal revisionism going on.
    Remember, this was the period of the crash, circa 2011.

    Changes were forced in and negotiated in part. The increase of the working week was brought in and was negotiated in exchange with the agreement of the Unions to not cut pay further.

    Now, the same Unions want to revert to the old style 35 hour week. Hardly the hallmark of a forward-thinking dynamic and modern organisation that wants to impliment the best standards in work and recruitment.

    You asked for examples, I gave examples. Of course there was negotiation - thats the point of a union.

    I provided far more examples than just the working week one although that is the most straightforward one to point out.

    Why wouldn't they want to revert to the 35 hour week. This is a change they are initiating and of course they are receptive to change once negotiated.


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  • Posts: 0 [Deleted User]


    markodaly wrote: »
    There is a lot of historcal revisionism going on.
    Remember, this was the period of the crash, circa 2011.

    Changes were forced in and negotiated in part. The increase of the working week was brought in and was negotiated in exchange with the agreement of the Unions to not cut pay further.

    Now, the same Unions want to revert to the old style 35 hour week. Hardly the hallmark of a forward-thinking dynamic and modern organisation that wants to impliment the best standards in work and recruitment.

    you seem to think that unions should only want what you, a standard-issue small govt advocate (from the face of it on this thread) wants

    now, its a fair way away from what the thread is about, although yes the fact that the public service is unionised is a factor in change being slow.

    the fact that the public service is huge, not run by any one entity, based on non-profit measurables, obliged to provide services based on full coverage need and not what is profitable/efficient, subject to strategic planning over the course of decades where the vision must survive changes of government as policy drivers, yadda yadda yadda

    you want it to be simple because all of your points are simple.

    its not simple. that may never suit you, im sorry.

    for current thread topic purposes, nobody is going to argue with you that the unions dont serve the public good, thats simply not their function.

    their function is to represent members at the meetings where the other social partners are represented in turn

    your focus on the union not playing any other part would be akin to me complaining that you arent volunteering to pay more taxes to cover public sector pay rises.

    id like it to happen. you are against it. the govt aint asking me, but i have the union at the table.

    you get a vote, you get lobby groups like IBEC and others, its all in the mix.


  • Registered Users, Registered Users 2 Posts: 14,862 ✭✭✭✭markodaly


    kippy wrote: »
    Yeah, unions make it more difficult to reform because:
    1. It's much more difficult(impossible almost) to fire staff.
    2. It's much more difficult to redeploy staff en masse.
    3. It's generally more difficult to reduce wages.
    4. It's more difficult to amend employment contracts.
    These are all standard in unionised environments.
    But they do not "Block Reform" en masse - as I have already shown.

    You listed 4 compelling reasons as to why unions block reform just there, yet you think that unions have zero responsibility in the way our public service or run or should I say badly run.

    Getting back to the OP here, this is what we are faced with. Paying tax for substandard services like health. We know it needs reform but for reasons outlined by you its neigh on impossible to reform it up to standard, so we just shrug and accept it, as the way it is.
    The electorates expectations (which would include union members and every other joe soap) are a big issue. Everyone wants a hospital in their back yard. Everyone wants a doctor within walking distance. This in turn drives policy and politics.

    This I can agree with. Everyone wants an airport, a hospital or a post office right next to them. Everyone wants reform and change until of course its their turn to be reformed or changed. Then its out on the picket line.


  • Registered Users, Registered Users 2 Posts: 14,862 ✭✭✭✭markodaly



    for current thread topic purposes, nobody is going to argue with you that the unions dont serve the public good, thats simply not their function.

    This is the standard rebuttal to any questioning of union involvement in the public sector. That they are only representing their members' interest.

    It is a way to absolve morally and politically any responsibility from the unions in regards to the state of our public services.

    I note of interest that everyone is in agreement that the health service (to take an example) and HSE are not up to standard and that it needs work. Everyone agrees that unionised work environments are slow to change and reform.

    But when it comes to the crunch, we get the same pandered response, that well unions do what unions do. "So what?"

    To achieve better public services we need to neuter the power that unions hold over the government of the day to enact and execute reform when needed.
    This is not 'small government' mentality, this is actually a pro-government mentality to deliver the best public services it can for the tax we contribute.


  • Posts: 0 [Deleted User]


    markodaly wrote: »
    This is the standard rebuttal to any questioning of union involvement in the public sector. That they are only representing their members' interest.

    It is a way to absolve morally and politically any responsibility from the unions in regards to the state of our public services.

    I note of interest that everyone is in agreement that the health service (to take an example) and HSE are not up to standard and that it needs work. Everyone agrees that unionised work environments are slow to change and reform.

    But when it comes to the crunch, we get the same pandered response, that well unions do what unions do. "So what?"

    To achieve better public services we need to neuter the power that unions hold over the government of the day to enact and execute reform when needed.
    This is not 'small government' mentality, this is actually a pro-government mentality to deliver the best public services it can for the tax we contribute.

    the parts you decline to respond to are very telling.

    where does one even get a soapbox in this day and age


  • Registered Users, Registered Users 2 Posts: 14,862 ✭✭✭✭markodaly


    the parts you decline to respond to are very telling.

    where does one even get a soapbox in this day and age

    I am laying bare the hypocrisy at play here by all. Politicians, the electorate and Unions.

    I lay the blame with the electorate really at the end of the day because they want opposite things at the same time, politicians lie to us and tell us that yes we can have everything we want all the time, and Unions stand in the way of any meaningful change and reform, unless we pay them off but sure they are only standing up for their members.

    We had a classic example of speaking with forked tongues on this very thread by one of its most prominent contributors and I took him to task on it. Seems to have gone quiet lately with not much else to say after the fact though.


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  • Posts: 0 [Deleted User]


    anyone else you want to blame aside from politicians, the electorate and the unions?

    i dont think you are laying anything bare tbh man.

    anytime somebody engages with you, you slide away from the complexity of the topic and pick the narrowest easy interpretation to attack in another broadside.

    i dunno is that the vital service you seem to consider it, but i dont blame whichever poster you refer to above from tiring of it pretty quickly.


  • Registered Users Posts: 201 ✭✭Sir Guy who smiles



    The focus of government should be on slowly and proportionately making things better. If people are too dismissive of how the country is run, nothing will change IMO, as each fresh scandal will be met with shurgged shoulders and an "ah sure what do you expect" attitude. Which is kind of what got us here in the first place

    Nail on the head.
    Slightly more of us are slightly better off then people in a lot of countries. When you consider our small scale and lack or resources this is better again than we think.

    Things could be better, yes, but a lot of places they are worse. We do like to feel hard done by!


  • Registered Users Posts: 201 ✭✭Sir Guy who smiles


    keithm1 wrote: »
    Sorry I can’t personally fault any 1 person.every one feels there busy.
    It’s the business model that’s inefficient.
    I’ve worked as a subcontractor to both public and private sectors for many years,
    If you brought me into an office floor blindfolded with no signage 9/10 times I could tell you if it was public or private within minutes

    I don't know what kind of subcontractor you are, so this is not a personal attack, but one of the inefficiencies in tax spend is because suppliers to the public sector will charge a lot more than they would to private sector clients.

    The most egregious ones I've seen are builders and associated tradesman doing work for the OPW. Once they know it's an OPW job the price shoots up, because they know they will get it.


  • Registered Users Posts: 201 ✭✭Sir Guy who smiles


    quokula wrote: »
    Having lived in other parts of Europe, Ireland does have a pretty poor tax-to-service ratio. However I don't think I've seen any evidence that the public sector or projects are generally any more wasteful here, or that more privatisation would magically solve anything. Every country has its issues with projects over running and services not meeting expectations.

    I think it's mostly down to circumstances, like the legacy of being a colony. We'd have far better public transport for our money if an army of slaves had built a network of rail tunnels under Dublin in the early 20th century, but that didn't happen. Really we've been playing catch up from no adequate infrastructure over the last half a century. On top of that we're a fairly sparsely populated island at the edge of the continent, which doesn't lend itself to getting good value for money either.

    Your last line is a huge point; economies of scale are not available to us.

    And that applies to the private sector too; things are cheaper in the shops in UK because more people are buying them.


  • Closed Accounts Posts: 16,013 ✭✭✭✭James Brown


    Nail on the head.
    Slightly more of us are slightly better off then people in a lot of countries. When you consider our small scale and lack or resources this is better again than we think.

    Things could be better, yes, but a lot of places they are worse. We do like to feel hard done by!

    You contradicted your own message there. Nail on the head is seeking to improve not 'sure it's worse elsewhere' (paraphrasing) which was a disgusting sentiment coming from Varadkar regarding homelessness IMO.

    Vast amounts of tax payer monies are wasted year on year, if I were a right wing, fiscal conservative I'd be looking for government to change tack and fast.


  • Registered Users, Registered Users 2 Posts: 18,781 ✭✭✭✭kippy


    You contradicted your own message there. Nail on the head is seeking to improve not 'sure it's worse elsewhere' (paraphrasing) which was a disgusting sentiment coming from Varadkar regarding homelessness IMO.

    Vast amounts of tax payer monies are wasted year on year, if I were a right wing, fiscal conservative I'd be looking for government to change tack and fast.

    I don't disagree but what do you mean by "Wasted"


  • Closed Accounts Posts: 16,013 ✭✭✭✭James Brown


    kippy wrote: »
    I don't disagree but what do you mean by "Wasted"

    Emergency accommodation; Hotels, rent subsidies, Children's hospital over run, Irish Water, Reilly's clinic allocation, broadband plan, Sitserv deal, selling houses to vulture funds and buying back off them, shady inappropriate behaviour by Noonan, (details may come out over the years) buying houses at market rates to use as social housing because we've no stock, Garda using tax payer money for paperless contracts... I'm missing a few I'm sure but all possible to address or avoid.


  • Posts: 0 [Deleted User]


    none of that is good. not sure how it compares to anywhere else but its not defensible, obviously

    now, in context, why do you think it is that ireland continuously votes in the type of public servant that seems prone to this type of thing?

    because wishing we had perfect people in a perfect system is not as useful as looking st what we have, what is actually normal in a country like ours, and analysing where we are different and why.

    that would be an interesting thread/topic.


  • Registered Users, Registered Users 2 Posts: 14,862 ✭✭✭✭markodaly


    anyone else you want to blame aside from politicians, the electorate and the unions?

    i dont think you are laying anything bare tbh man.

    anytime somebody engages with you, you slide away from the complexity of the topic and pick the narrowest easy interpretation to attack in another broadside.

    i dunno is that the vital service you seem to consider it, but i dont blame whichever poster you refer to above from tiring of it pretty quickly.

    Well, turning back to the OP's question then, do we pay too much tax for crappy services.

    Are you for example happy with the health service, and if not why not?
    What would you change?


  • Registered Users Posts: 201 ✭✭Sir Guy who smiles


    You contradicted your own message there. Nail on the head is seeking to improve not 'sure it's worse elsewhere' (paraphrasing) which was a disgusting sentiment coming from Varadkar regarding homelessness IMO.

    Vast amounts of tax payer monies are wasted year on year, if I were a right wing, fiscal conservative I'd be looking for government to change tack and fast.

    By that I didn't mean "Ireland isn't the worst, we don't need to get better".
    I meant "we have problems, which we should try to cure".

    The whole attitude of "Ireland is the worst country in the world and I won't get involved or try to help because one shower is as bad as the other" leads to people not getting involved, just moaning online and in the pub about how they would sort things out, but never getting up off their fat arse and implementing their wondrous solutions.

    Johnnyskeleton said " If people are too dismissive....nothing will change" and that is what I said "nail on the head" to.


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